Transcript Terminology of the Skin - Home

Skin Terminology
Rich Callahan PA-C,
ICM I
Summer 2009
It’s all about the descriptive
terminology!
Dermatology unique in that PE
almost entirely visual, and you need
to accurately and quickly describe
what you see.
Description of skin lesions always has the
same basic parameters
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Type of skin lesion (papule, macule, etc)
Color
Margination
Consistency
Shape
Arrangement
Distribution (where anatomy comes in!)
Descriptive Terminology: Types of Skin
Lesions
• Papule – a solid, raised lesion 5mm or less in
diameter
• Macule – a defined, flat area whose color is
distinctly different from surrounding skin (larger
version of macule is patch) 1 cm or less in
diameter
• Plaque – a raised, superficial, solid lesion 5mm or
more in diameter (when papules become confluent
with one another they become plaques)
• Nodule – well-defined, deeply seated lesion
>5mm diameter. A large nodule is called a tumor.
Descriptive Terminology
• Pustule – flat to slightly raised, defined pocket of
leukocytes/serous fluid, any size
• Vesicle – a blister up to 5mm diameter
• Bulla – blister greater than 5mm diameter. Plural
is bullae
• Wheal – firm, edematous papules and plaques.
Usually transitory (hives.) No appreciable surface
textural changes (epidermis unaffected.)
Descriptive Terminology
• Scale – dead epidermis – “white flakes”
• Crust – Dried serum, blood, etc. “Scab”
• Erosion – An area of skin where the outer layer
(epidermis) has been eroded away. By definition,
superficial to dermoepidermal junction, will not
cause a scar.
• Ulceration – Similar to erosion, but defect
penetrates into dermis.
• Fissure – Sharply defined crack in the skin which
penetrates down to dermis
Color
• Any color you see as appropriately descriptive,
using language that another person reading your
notes would understand.
• Red, blue, green, black, light/dark brown, orange,
magenta, cayenne pepper, etc.
• Is there mixing of colors, and if so is it
symmetrical-appearing?
• Example: When pressed with a glass slide, skin
lesions of sarcoidosis often blanch and take on an
“apple jelly” color
A few physical exam findings need to be
described more specifically however!
• Erythema (from Greek “to redden”) – That
unique redness seen in human skin resulting
from enlargement (congestion) of blood
vessels. Usually blanches with manual
pressure. Classic example is sunburn seen
in fair-skinned people. Individual blood
vessels often visible with magnification.
A few physical exam findings need to be
described more specifically however!
• Purpuric, or violaceous – has the purplish
color of a bruise, and does not blanch when
pressed with glass slide. Due to direct
extravasation(blood left vessels into tissues)
of blood into dermis.
• Important to recognize/describe this type of
lesion as is presenting sign of many
important diseases and injuries.
Margination
• Sharply marginated; well-defined
• Poorly defined; hazy borders – can seem like
gradual transition from lesion to normal skin.
• Borders can be linear, arcuate, geographic
• Borders can be regular: Composed of smooth,
generally straight lines.
• Borders can be irregular: Composed of varying,
squiggly, generally crooked lines.
Consistency
• Firm, soft, hard, gelatinous, etc.
• Rubbery, tissue paper, boggy, warty, stuckon appearing, moist, gritty, cracked china,
crazy pavement, fish scale, greasy, etc…..
• Hot/cold/warm
• Freely mobile vs. fixed
• Tenderness to palpation
Shape
• Round, trapezoidal, polygonal, ovular, annular,
polycyclic, serpiginous, linear, etc.
• Can get more descriptive: star-shaped, pac-man,
ink spot, umbilicated, etc.
• Example: Nummular eczema, comes for the Latin
word for “coin” because characteristic lesions are
homogenous and round, usually somewhere
between the size of a nickel or quarter.
Arrangement
(I.e., the way in which lesions are distributed on the
patient.)
• Scattered, or disseminated; widespread. Can be
many or few. Alternatively, can be localized;
discrete.
• Groups of lesions can be arranged in annular,
linear, arciform, reticulated, serpiginous or
herpetiform shapes.
• “Buckshot” – lesions appear scattered in a way
reminiscent of the scattering of shot from a
shotgun barrel
• Is there symmetry in arrangement of lesions
between body areas, or does it appear random?
Distribution
• Where on the body do the lesions present, and
to what extent? – isolated, localized, regional,
widespread. Describing a specific area comes
down to surface anatomy.
• Anatomic patterns: Intertriginous, follicular,
dependent areas, dermatomal, etc. Flexor/extensor
extremities
• Is it limited to sites of sun-exposure,
windburn,pressure, contact with clothing,
furniture, etc?
Putting it all together
• Let’s check out some skin lesions and talk
about how to describe them!